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Physiotherapy Management on Knee Osteoarthritis (OA)

What is osteoarthritis (OA) of the knee?

Osteoarthritis of the knee is reported to be a major health problem worldwide and the most common arthritis in Malaysia.

What happens in knee Osteoarthritis?

Knee osteoarthritis (OA) is a degenerative arthritis caused by overstresses affecting the bone cartilage of the knee that gradually wears away causing inflammation, pain and functional limitation. Knee cartilage that absorbs the shock during activity will gradually worsen due to the excessive loading. The condition progressively becomes critical in the older age due to lack of joint lubricant production.

Some of the major changes that occur in the knee joint of a person suffering from knee osteoarthritis (OA) include:

  1. Narrowing of the joint space due to wear of the cartilage.

  2. Formation of bony outgrowths (osteophytes) at the margin of the bone.

  3. Decrease in production of joint lubricant.

  4. Pain aggravated with weight bearing tasks due to friction of both ends’ bone and further bone erosion.

Source: Rheumatology.org

What are the symptoms of knee osteoarthritis?

  • The main symptom is morning pain and stiffness.
  • Reluctance in doing optimum activity leads to smaller and weaker legs muscles.
  • ‘Clicks’ sound from margin of the bones associated with intense pain.
  • Other symptoms are occasional swelling, effusion and reduced joint range.
  • Limitation of the physical activity drops the person’s quality of life.

Risk factors for knee osteoarthritis?

  • Age – 9.3% of adult Malaysians suffer with knee osteoarthritis of this, 23% of the adults are aged more than 55 years and 39% more than 65 years.

  • Gender – More women suffer with knee OA compared to men.

  • Sports injuries – The person with a history of knee injury is at a fivefold to six fold increased risk to develop knee osteoarthritis.

  • Nature of daily activity – Person who is involved in vigorous heavy physical work with a lot of knee action like bending, squatting, kneeling

  • Body Mass Index (BMI) – Overweight produces higher loads specifically to the knee compartment of both knees.

What you need to do during early stage of knee osteoarthritis?

Provide initial relief of pain follow the PRICE regimen:

  1. Protection Assisted walking aids seems to reduce some load from the affected knee.

  2. Rest Adequate rests need to be taken, stop doing any strenuous activity such as prolonged standing, climbing stairs, kneeling or squatting for some time.

  3. Ice Applied up to 15 minutes for several times per day. Ice massage and cold packs will improve knee joint range, function and strength and decrease swelling. Some patients prefer the moist heat for pain relief.

  4. Compression If swelling exists, wrapping with an elastic bandage to improve the circulation

  5. Elevation will help in diminishing swelling.

What is the physiotherapy management for knee osteoarthritis?

  1. Modalities – Heat and cold therapy is applied to enhance relaxation and reduces pain. Pulsed electrical stimulation can be useful to promote the blood circulation.

  1. Exercise – Stretching and strengthening exercises need to be done regularly to maintain the endurance and flexibility. More unloading exercises will be prescribed to prevent further trauma of the knee.

    Example: Stretching and strengthening exercises
    Source: Unit Fisioterapi, Hospital Melaka
  1. Balance training – Balance training is to train postural stability especially is the older adults with impaired balance.

    Example: Balance training
    Source: Unit Fisioterapi, Hospital Melaka
  1. Joint protection – Flexibility, strength and joint sense are optimized in hopes of reducing joint stresses, decreasing shock impacts to the joint and maximizing joint movement and alignment.

    Example: Joint protection
    Source: Unit Fisioterapi, Hospital Melaka
  1. Advice to patient

    1. Assist walking with cane or walker to minimize the hip and knee loading, thereby reducing pain. It may also prevent falls in patients with impaired balance.

    2. Avoid any strenuous daily activity that gives more trauma to the knee joint such as stairs climbing and hill hiking.


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Source image

  1. (2013) Rhematology Image bank. Retrieved July 4 2013. http://images.rheumatology.org/viewphoto.php?albumId=77030&imageId=2897682

  2. (2012) Unit Fisioterapi Hospital Melaka. Retrieved July 4 2013.

Last Reviewed : 23 August 2019
Writer : Mohd Naqiuddin bin Johar
Accreditor : Daaljit Singh a/l Harbachan Singh
Reviewer : Halimah bt. Hashim